In another study, a small observational chart review performed by Elwood et al.
Unfortunately, extensive studies have not been performed to identify specific patients at risk and aid in the development of evidence-based clinical protocols for patients with neurologic pathology and developmental disabilities.
Most reported experience refers to scattered case reports of specific syndromes (Butler et al.
Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 Queen Lane, Philadelphia, PA 19129, USAReceived 2 December 2009; Revised 15 June 2010; Accepted 20 June 2010Academic Editor: Savithiri Ratnapalan Copyright © 2010 Todd J. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sedation and analgesia performed by the pediatrician and pediatric subspecialists are becoming increasingly common for diagnostic and therapeutic purposes in children with developmental disabilities and neurologic disorders (autism, epilepsy, stroke, obstructive hydrocephalus, traumatic brain injury, intracranial hemorrhage, and hypoxic-ischemic encephalopathy).
Search terms included “sedation”, and “analgesia”, “pediatric”, “child”, “neonate”, “brain”, “developmental disabilities”, “neurologic”, “autism”, “epilepsy”, “seizure”, “stroke”, “hydrocephalus”, “traumatic brain injury”, “intracranial hemorrhage”, “hypoxia-ischemia”, and “encephalopathy” and the period of search was from 1960–2010.
The authors are pediatric neurocritical care specialists and have extensive clinical experience caring for pediatric patients with developmental disabilities and neurologic disorders and research experience in experimental animal models of pediatric neurologic injury.
However, the patients classified as having developmental disability had a threefold increased incidence of hypoxia (11.9% versus 4.9%; ).
These findings seem to recapitulate the findings described in the PSRC studies: an increase in adverse events, most notably airway compromise, for children with developmental disabilities and those with neurologic disorders.
Brain MRI has become an important diagnostic and management tool for these children and is being increasingly used in many pediatric centers .
Kannikeswaran and colleagues recently published a retrospective review of children, 1–18 years of age, sedated for brain MRI with and without developmental disability .
The American Academy of Pediatrics, Section on Anesthesiology has published Guidelines for the Pediatric Perioperative Anesthesia Environment, which includes suggestions for age categorization, need for intensive care following sedation for recovery, and presence of coexisting disease .